To paraphrase what Henry James' once said of Louisa May Alcott, my experience of genius is small but my admiration for it is, nevertheless, great. When I visited the "Figarohaus" in Vienna - where Mozart lived and worked for two crucial years - I experienced a great fatigue, the sort that comes with acceptance. In the presence of real genius, I slumped into a chair and listened for one listless hour to its fruits: symphonies, the divine Requiem, arias, a cornucopia.

I always wanted to be a genius. Partly as a sure-fire way to secure constant narcissistic supply, partly as a safeguard against my own mortality. As it became progressively more evident how far I am from it and how ensconced in mediocrity - I, being a narcissist, resorted to short cuts. Ever since my fifth year, I pretended to be thoroughly acquainted with issues I had no clue about. This streak of con-artistry reached a crescendo in my puberty, when I convinced a whole township (and later, my country, by co-opting the media) that I was a new Einstein. While unable to solve even the most basic mathematical equations, I was regarded by many - including world class physicists - as somewhat of an epiphanous miracle. To sustain this false pretence, I plagiarized liberally. Only 15 years later did an Israeli physicist discover the (Australian) source of my major plagiarized "studies" in advanced physics. Following this encounter with the abyss - the mortal fear of being mortifyingly exposed - I stopped plagiarizing at the age of 23 and has never done so since.

I then tried to experience genius vicariously, by making friends with acknowledged ones and by supporting up and coming intellectuals. I became this pathetic sponsor of the arts and sciences that forever name drops and attributes to himself undue influence over the creative processes and outcomes of others. I created by proxy. The (sad, I guess) irony is that, all this time, I really did have a talent (for writing). But talent was not enough - being short of genius. It is the divine that I sought, not the average. And so, I kept denying my real self in pursuit of an invented one.

As the years progressed, the charms of associating with genius waned and faded. The gap between what I wanted to become and what I have has made me bitter and cantankerous, a repulsive, alien oddity, avoided by all but the most persistent friends and acolytes. I resent being doomed to the quotidian. I rebel against being given to aspirations which have so little in common with my abilities. It is not that I recognize my limitations - I don't. I still wish to believe that had I only applied myself, had I only persevered, had I only found interest - I would have been nothing less of a Mozart or an Einstein or a Freud. It is a lie I tell myself in times of quiet despair when I realize my age and compare it to the utter lack of my accomplishments.

I keep persuading myself that many a great man reached the apex of their creativity at the age of 40, or 50, or 60. That one never knows what of one's work shall be deemed by history to have been genius. I think of Kafka, of Nietzsche, of Benjamin - the heroes of every undiscovered prodigy. But it sounds hollow. Deep inside I know the one ingredient that I miss and that they all shared: an interest in other humans, a first hand experience of being one and the fervent wish to communicate - rather than merely to impress.

next: The Narcissist in Love - Emotionally Attached to Narcissism

I often find myself worried. I say "find myself" because it is usually unconscious, like a nagging pain, a permanence, like being immersed in a gelatinous liquid, trapped and helpless. Perhaps the phrase I am looking for is the DSM favourite "All-pervasive". Still, it is never diffuse. I am worried about specific people, or possible events, or more or less plausible scenarios. It is just that I seem to constantly conjure up some reason or another to be worried. Positive past experiences have not dissuaded me from this pre-occupation. I seem to believe that the world is a cruelly arbitrary, ominously contrarian, contrivingly cunning and indifferently crushing place. I know it will all end badly and for no good reason. I know that life is too good to be true and too bad to endure. I know that civilization is an ideal and that the deviation from it are what we call "history". I am incurably pessimistic, an ignoramus by choice and incorrigibly blind to evidence to the contrary.

Underneath all this is a Great Anxiety. I fear life and what people do unto each other. I fear my fear and what it does to me. I know I am a participant in a game whose rules I will never know and that my very existence is at stake. I trust no one, I believe in nothing, I know only two certainties: evil exists and life is meaningless. I am convinced that no one cares. I am a pawn without a chessboard with the chess players long departed. In other words: I float.

This existential angst that permeates my every cell is atavistic and irrational. It has no name or likeness. It is like the monsters in every child's bedroom with the lights turned off. But being the rationalizing and intellectualising cerebral narcissist that I am - I must instantly label it, explain it, analyse it and predict it. I must attribute this poisonous cloud that weighs on me from the inside to some external cause. I must set it in a pattern, embed it in a context, transform it into a link in the great chain of my being. Hence, diffuse anxiety become my focused worries. Worries are known and measurable quantities. They have a mover which can be tackled and eliminated. They have a beginning and an end. they are tied to names, to places, faces and to people. Worries are human - anxiety divine. I thus, transform my demons into notation in my diary: check this, do that, apply preventive measures, do not allow, pursue, attack, avoid. The language of human conduct in the face of real and immediate danger is cast as blanket over the underlying abyss that harbours my anxiety.

But such excessive worrying - whose sole intent is to convert irrational anxiety into the mundane and tangible - is the stuff of paranoia. For what is paranoia if not the attribution of inner disintegration to external persecution, the assignment of malevolent agents from the outside to the turmoil inside? The paranoid seeks to alleviate his voiding by irrationally clinging to rationality. Things are so bad, he says, mainly to himself, because I am a victim, because "they" are after me and I am hunted by the juggernaut of state, or by the Freemasons, or by the Jews, or by the neighbourhood librarian. This is the path that leads from the cloud of anxiety, through the lamp posts of worry to the consuming darkness of paranoia.

Paranoia is a defence against anxiety and against aggression. The latter is projected outwards, upon imaginary other, the agents of one's crucifixion.

Anxiety is also a defence against aggressive impulses. Therefore, anxiety and paranoia are sisters, the latter but a focused form of the former. The mentally disordered defend against their own aggressive propensities by either being anxious or by becoming paranoid.

Aggression has numerous faces. One of its favourite disguises is boredom.

Like its relation, depression, it is aggression directed inwards. It threatens to drown the bored in a primordial soup of inaction and energy depletion. It is anhedonic (pleasure depriving) and dysphoric (leads to profound sadness). But it is also threatening, perhaps because it is so reminiscent of death.

I find myself most worried when I am bored. It goes like this: I am aggressive. I channel my aggression and internalise it. I experience my bottled wrath as boredom. I am bored. I feel threatened by it in a vague, mysterious way. Anxiety ensues. I rush to construct an intellectual edifice to accommodate all these primitive emotions and their transubstantiations. I identify reasons, causes, effects and possibilities in the outer world. I build scenarios. I spin narratives. I feel no more anxiety. I know the enemy (or so I think). And now I am worried. Or paranoid.

next: A Great Admiration

That the Narcissist possesses a prominent False Self as well as a suppressed and dilapidated True Self is common knowledge. Yet, how intertwined and inseparable are these two? Do they interact? How do they influence each other? And what behaviours can be attributed squarely to one or the other of these protagonists? Moreover, does the False Self assume traits and attributes of the True Self in order to deceive?

Two years ago, I suggested a methodological framework. I compared the Narcissist to a person suffering from the Dissociative Identity Disorder (DID) - formerly known as the "Multiple Personality Disorder" (MPD).

Here is what I wrote:

"A debate is starting to stir: is the False Self an alter? In other words: is the True Self of a narcissist the equivalent of a host personality in a DID (Dissociative Identity Disorder) - and the False Self one of the fragmented personalities, also known as 'alters'?"

"My personal opinion is that the False Self is a mental construct, not a self in the full sense. It is the locus of the fantasies of grandiosity, the feelings of entitlements, omnipotence, magical thinking, omniscience and magical immunity of the narcissist. It lacks so many elements that it can hardly be called a 'self'."

"Moreover, it has no 'cut-off' date. DID alters have a date of inception, being reactions to trauma or abuse. The False Self is a process, not an entity, it is a reactive pattern and a reactive formation. All taken into account, the choice of words was poor. The False Self is not a Self, nor is it False. It is very real, more real to the narcissist than his True Self. A better choice would have been 'abuse reactive self' or something like this."

"This is the core of my work. I say that narcissists have vanished and have been replaced by a False Self (bad term, but not my fault, write to Kernberg). There is NO True Self in there. It's gone. The Narcissist is a hall of mirrors - but the hall itself is an optical illusion created by the mirrors ... This is a little like the paintings of Escher."

"MPD (DID) is more common than believed. The emotions are the ones to get segregated. The notion of 'unique separate multiple whole personalities' is primitive and untrue. DID is a continuum. The inner language breaks down into a polyglottal chaos. Emotions cannot communicate with each other for fear of the pain (and its fatal results). So, they are kept apart by various mechanisms (a host or birth personality, a facilitator, a moderator and so on)."

"And here we come to the crux of the matter: All PDs - except NPD - suffer from a modicum of DID, or incorporate it. Only the narcissists don't. This is because the narcissistic solution is to emotionally disappear so thoroughly that not one personality/emotion is left. Hence, the tremendous, insatiable need of the narcissist for external approval. He exists ONLY as a reflection. Since he is forbidden from loving his true self - he chooses to have no self at all. It is not dissociation - it is a vanishing act."

"This is why I regard pathological narcissism as THE source of all PDs. The total, 'pure' solution is NPD: self extinguishing, self abolishing, totally fake. Then come variations on the self hate and perpetuated self abuse themes:
HPD (NPD with sex or the body as the source of narcissistic supply), BPD (emotional lability, movement between poles of life wish and death wish) and so on.
Why are narcissists not prone to suicide? Simple: they died a long time ago.
They are the true zombies of the world. Read vampire and zombie legends and you will see how narcissistic these creatures are."

Many researchers and scholars and therapists tried to grapple with the void at the core of the Narcissist. The common view is that the remnants of the True Self are so ossified, shredded, cowed into submission and repressed - that, for all practical purposes, they are functionless and useless. In treating the Narcissist, the therapist often tries to invent a healthy self, rather than build upon the distorted wreckage strewn across the Narcissist's psyche.

But what of the rare glimpses of True Self that the unfortunates who interact with Narcissists keep reporting?

If the pathological narcissistic element is but one of many other disorders - the True Self may well have survived. Gradations and shades of narcissism occupy the narcissistic spectrum. Narcissistic traits (overlay) are often co-diagnosed with other disorders (co-morbidity). Some people have a narcissistic personality - but NOT NPD! These distinctions are important.

A person may well appear to be a narcissist - but is not, in the strict, psychiatric, sense of the word.

In a full-fledged Narcissist, the False Self IMITATES the True Self.

To do so artfully, it deploys two mechanisms:

RE-INTERPRETATION

It causes the Narcissist to re-interpret certain emotions and reactions in a flattering, True Self-compatible, light. A Narcissist may, for instance, interpret FEAR - as compassion. If I hurt someone I fear (e.g., an authority figure) - I may feel bad afterwards and interpret my discomfort as EMPATHY and COMPASSION. To be afraid is humiliating - to be compassionate is commendable and earns me social acceptance and understanding.

EMULATION

The Narcissist is possessed of an uncanny ability to psychologically penetrate others. Often, this gift is abused and put at the service of the narcissist's control freakery and sadism. The Narcissist uses it liberally to annihilate the natural defences of his victims by faking unprecedented, almost inhuman, empathy.

This capacity is coupled with the Narcissist's ability to frighteningly imitate emotions and their attendant behaviours. The Narcissist possesses "resonance tables". He keeps records of every action and reaction, every utterance and consequence, every datum provided by others regarding their state of mind and emotional make-up. From these, he then constructs a set of formulas which often result in impeccably and eerily accurate renditions of emotional behaviour. This is enormously deceiving.

The Narcissist is our first encounter with carbon-based artificial intelligence. Many wish it were the last.

next: The Anxiety of Boredom - Most Worried When I Am Bored

Find out what makes the Internet so addictive to some that they become Internet addicts.

The Internet itself is a term which represents different types of functions that are accessible on-line. Generally speaking, Internet Addicts tend to form an emotional attachment to the on-line friends and activities they create inside their computer screens. They enjoy those aspects of the Internet which allowed them to meet, socialize, and exchange ideas with new people through highly interactive Internet applications (such as chatting, playing on-line games, or being involved with social networks). These virtual communities create a vehicle to escape from reality and seek out a means to fulfill an unmet emotional and psychological need.

On the Internet, you can conceal your real name, age, occupation, appearance, and your physical responses to anyone or anything you encounter on-line. Internet users, especially those who are lonely and insecure in real-life situations, take that freedom and quickly pour out their strongest feelings, darkest secrets, and deepest desires. This leads to the illusion of intimacy, but when reality underscores the severe limitations of relying on a faceless community for the love and caring that can only come from actual people, Internet addicts experience very real disappointment and pain.

In Caught in the NET, you will learn more about why the Internet is addictive and recovery strategies to prevent and avoid the pitfalls of the Information Superhighway. Click here to order Caught in the Net

Our Virtual Clinic provides email, chat room, and telephone therapy for immediate help.

If you are a mental health professional, please refer to our Seminars to arrange a full-day training workshop on the evaluation and treatment of compulsive Internet us

next: How Do You Treat Internet Addiction?
~ all center for online addiction articles
~ all articles on addictions

A Psychoeducational Program To Improve:

• Attention
• Concentration
• Academic Achievement
• Self-Control
• Self-Esteem

Key Features of Focus
How Focus Helps Children and Teens with Attention Deficit Disorder
How The Components Work Together
About The Author
Table of Contents
Research Studies Related To The Psychological Methods Used To Treat Attention Deficit Utilized In Focus
FREE Information and Materials on Attention Deficit Disorder

Key Features

Great for children ages 6 to 14 with ADD. (Two separate levels, one for younger and one for older children).

Can be used instead of medication or along with medication for the treatment of attention deficit disorder.

Easy to implement Behavior Modification Program improves academic achievement and classroom behavior.

Fun mental exercises (Brain Training) improve attention, concentration, impulse control and mental processing skills.

Entertaining motivational tape helps children feel good about themselves and encourages them to make the Focus program work for them.

Relaxation tapes use positive mental pictures to improve memory, listening, self-control and self-esteem.

Biofeedback Card helps children with attention deficit disorder learn to relax so they can slow down, pay attention and think before they do things.

The "Family Chip System" along with exercises to improve parent/child communication brings peace and happiness to the home environment.

Parent Educational materials provide in-depth information on attention deficit disorder along with useful suggestions and guides to additional resources.

Focus helps children with Attention Deficit Disorder become the winners they were meant to be.

How Focus Helps Children and Teens with Attention Deficit Hyperactivity Disorder

"I have been working with children and teens with ADHD for 20 years. When parents first accepted the diagnosis of attention deficit disorder for their son or daughter, they usually asked, 'is there something we can try besides medication?' My answer was yes. I found various tools could help children improve at school and at home. In some cases their teachers could not believe they got better without medication. I have also used these methods to help children and teens either get off medication or to improve their behavior and learning without increasing their medication.

While medication does change brain function and often improves symptoms in various psychiatric disorders, research has shown that psychological methods not only bring about improvement but the change is often permanent. Research has shown that in at least one disorder, brain function is also permanently changed by the psychological treatment. The methods used in Focus, have been shown to be successful in improving learning and behavior in children with attention deficit hyperactivity disorder through research studies.

Due to tight family budgets and managed care, fewer children have the opportunity to see a psychologist for an alternate approach to treatment . That is why I put all those tools together in a kit that can be used by parents in the home. Kids can receive the help they need in a way that is not only affordable and convenient but also highly effective. I encourage you to do what many other parents have done, give Focus a try. You and your child will be happy you did." - Robert Myers, PhD (Child Psychologist & Director, Child Development Institute)

How The Components of Focus Work Together To Help Children With Attention Deficit Disorder

Instruction Manual/Workbook

• Contains easy to follow instructions for entire program.
• Provides Charts & Graphs to record progress.
• Behavior Modification Programs For Home & School.
• Relaxation Exercises
• Cognitive Exercises (Brain Training)

Cassette Tapes

• Help children understand themselves.
• Help motivate children to complete the Focus program.
• Help children to use relaxation to pay attention.
• Help children to use relaxation to slow down and think.
• Help children to use mental pictures to solve problems.
• Help children to use relaxation and mental pictures to control their emotions.

Stress Sensor/Biofeedback Card

• Provides skin temperature biofeedback to help children monitor their stress level.
• Helps children increase their ability to relax which leads to improved attention and concentration as well as self-control.

Table of Contents

The Behavior Modification Program, Relaxation Tapes and Coaching Tapes have two levels. Level A is for children 6 - 10 while Level B is for 11-14. The two levels are provided in one program so that children that are either more or less advanced than their age group can use an approach that will work for them.

Instruction Manual Topics:

• Introduction
• Let's Get Focused (Using the Program)
• Improving Attention & Self-Control at School (Behavior Modification)
• Biofeedback/Relaxation Training
• Exercises to Improve Self-Control
• Exercises to Improve Attention & Learning
• Improving Attention & Self-Control at Home

(The Instruction Manual also includes Forms for Medication Management, Classroom Interventions For Teachers, A List of Attention Deficit Disorder Support Groups and a Detailed Bibliography)

Coaching Tape Topics:

• Let's Get Focused
• Learning To Slow Down & Think
• Learning To Pay Attention & Remember

[More Information On Scientific Research Related To Attention Deficit Disorder and Focus]

About the Author

Focus was developed by Dr. Robert Myers was developed by Dr. Robert Myers who is a clinical psychologist with over 20 years of experience working with children, adolescents, families and parents. He has specialized in working with children and adolescents with Attention Deficit Hyperactivity Disorder and Learning Disabilities. Dr. Myers earned his Ph.D. from the University of Southern California. In addition to his twenty years of private practice, he has also held a number of consulting contracts. These have included Clinical Director for several youth service inpatient units at College Hospital and Charter Hospital of Long Beach; Consulting Psychologist for Miller Children's Hospital at Long Beach Memorial Medical Center; Clinical Instructor (Pediatrics), Volunteer Faculty UCI College of Medicine; Adjunct Professor, Rosemead Graduate School of Psychology at BIOLA University. He has also provided community lectures on parenting and other topics. He has been a talk show host on KIEV and KORG in Southern California and has also appeared as a guest on many radio and television talk shows locally and nationally. He also was a regular columnist for Parents and Kids Magazine.

Focus Ordering Information

Please click here for more information and purchase of the Total Focus Program.

next: The Use of Focus with Children and Young Teens with Attention Deficit Disorder Is Backed by Clinical Research and Professional Practice

From the world's first Cyber-psychologist - Read Dr. Kimberly Young's groundbreaking new book: Caught in the Net: How to Recognize the Signs of Internet Addiction and A Winning Strategy for Recovery.

Published by John Wiley & Sons

As seen in USA Today, The Wall Street Journal, The London Times, The LA Times, Newsweek, Time - with translations already in German, Danish, Italian, and Japanese! Rating From Customer Reviews on Amazon Books!

As the book flap proclaims:

In Caught in the Net, Kimberly Young shares the results of her three-year study of Internet abuse. Often using the words of Internet addicts themselves, she presents the stories of dozens of lives that were shattered by an overwhelming compulsion to surf the Net, play virtual games, or chat with distant and invisible neighbors in the timeless limbo of Cyberspace. Why is the Internet so seductive? What are the warning signs of Internet addiction? Is recovery possible? Dr. Young answers these questions and many more. She provides a questionnaire to help Net users determine whether they are addicts and offers concrete steps for problem users to regulate Internet usage and devise a more balanced place for it in their daily lives. To Internet addicts as well as their parents, spouses, friends, and employers, Caught in the Net offers guidance on where and how to seek help from counselors, therapists, and other professionals who take this affliction seriously. For mental health professionals, this book provides insights into the nature and causes of Internet addiction and encourages counselors and therapists to expand their addiction recovery programs to address the specific problems of Internet addicts.

Click to order the book Caught in the Net.

See the table of contents and read the introduction.

next: Caught in the Net Table of Contents
~ all center for online addiction articles
~ all articles on addictions

Many teenagers face some form of sexual coercion, whether through peer pressure, or actually believing lines like "Don't you love me?" that they may hear from their boyfriend or girlfriend. Unfortunately, this pressure can take a more dramatic turn in the form of "date rape", an increasing problem. It's important for you as a parent to make sure your teenager is fully aware of the risks they face and that NOBODY has the right to force them into anything they are uncomfortable with.

How can a parent help their child or teen deal with coercion and sexual abuse?

As a parent, you need to help your child or teen understand what sexual abuse / coercion is and how they can protect themselves. Here are a few pointers:

• Don't just say be careful. Be specific, and give them examples.
• Don't just warn them about strangers, since offenders are often known to the child.
• Use proper names for sexual body parts. If your child can talk to adults more effectively, they are more likely to be taken seriously.
• Be sure they understand the difference between good and bad touches and that they always have the right to say NO to any touch they're uncomfortable with.
• Encourage your child to tell you about any incidents, stressing the fact that you will always believe them.
• Teach them to be "street smart" by, for example, making sure they know their address and home or work phone numbers, or using a family code word.
• Make sure they understand that even "nice" people, friends, or relatives can coerce them into dangerous situations.

It is important to note that the victim is not at fault; assault is generally more about anger and/or power over others rather than sex, and it may also be about sexual desire and attraction using power. Many are at risk, and most assailants are not strangers to their victims.

next: Sexual Communication: Talking to Your Parents About Sex

NIH analysis of SAMe for the treatment of depression indicates SAMe does decrease symptoms of depression.

The objective of this report was to conduct a search of the published literature on the use of S-adenosyl- L-methionine (SAMe) for the treatment of depression, osteoarthritis, and liver disease; and, on the basis of that search, to evaluate the evidence for the efficacy of SAMe. A broad search revealed sufficient literature to support a detailed review of the use of SAMe for three conditions: depression, osteoarthritis, and cholestasis of pregnancy and intrahepatic cholestasis associated with liver disease.

Depression will affect 10 to 25 percent of women and 5 to 12 percent of men in the United States during their lifetimes. Approximately 10 to 15 million people experience clinical depression in any given year. The annual cost for treatment and lost wages is estimated at $43.7 to $52.9 billion.

Osteoarthritis is the most common form of arthritis. An estimated 15 percent of Americans suffer from arthritis, and the annual cost to society is estimated at $95 billion. It is the second most common cause cited in claims for Social Security disability benefits.

Intrahepatic cholestasis of pregnancy occurs in 1 in 500 to 1000 pregnancies and is associated with an increased risk of premature delivery and fetal death. Intrahepatic cholestasis is a relatively common complication of a number of acute and chronic liver diseases such as viral hepatitis, alcoholic hepatitis, and autoimmune liver diseases. In two series of chronic liver disease patients, 35 percent had intrahepatic cholestasis characterized by elevations of bilirubin and liver enzymes. While an economic cost is difficult to assign to cholestasis, pruritus causes significant morbidity in affected patients.

Empirical evidence of the efficacy of SAMe for the treatment of these three conditions would be helpful to health care providers who manage them and would be useful in identifying areas for future research.

Reporting the Evidence

Searches of the literature yielded 1,624 titles, of which 294 were selected to review; the latter included meta-analyses, clinical trials, and reports that contained supplemental information on SAMe. Ninety-nine articles, representing 102 individual studies, met the screening criteria. They focused on SAMe treatment for depression, osteoarthritis, or liver disease and presented data from clinical trials on humans. Of these 102 studies, 47 focused on depression, 14 focused on osteoarthritis, and 41 focused on liver disease (all conditions).

Methodology

A panel of technical experts representing diverse disciplines was established to advise the researchers throughout the research. In consultation with the funding agencies and taking into account the uses for which SAMe was generally recommended, the use of SAMe to treat depression, osteoarthritis, and liver disease was selected as the focus of the report. The aim was to perform a meta-analysis whenever the literature was appropriate for such an analysis.

Search Strategy

Twenty-five biomedical databases were searched through year 2000: MEDLINE®, HealthSTAR, EMBASE, BIOSIS Previews®, MANTIS, Allied and Complementary Medicine, Cochrane™ Library, CAB HEALTH, BIOBASE, SciSearch®, PsychINFO, Mental Health Abstracts, Health News Daily, PASCAL, TGG Health & Wellness DB, and several pharmaceutical databases. The researchers searched using the term SAMe and its many pharmacological synonyms, the three focus disease states, study design, and article type. They also searched the bibliographies of review and meta-analysis articles and questioned experts to identify additional citations. An additional 62 articles were identified from these sources, particularly from review articles and from citations suggested by the advisors.

Selection Criteria

Reports were included in the synthesis of evidence if they focused on SAMe for one of the selected diseases and presented the results of randomized clinical trials on human subjects. Language of publication was not a barrier to inclusion. About 25 percent of the selected studies were in foreign languages, mainly Italian.

Data Collection and Analysis

All selected titles, abstracts, and articles, in all languages, were reviewed independently by two reviewers who were fluent in the appropriate language, and all disagreements were resolved by consensus. Information was collected about patient demographics, disease state, intervention, study design, and outcomes. Sufficient numbers of homogeneous studies existed to permit a meta-analysis of the efficacy of SAMe for treatment of four conditions: depression versus placebo and active (pharmacological) therapy, osteoarthritis versus placebo and active (pharmacological) therapy, cholestasis of pregnancy versus placebo and active therapy, and intrahepatic cholestasis associated with liver disease versus placebo. The remainder of the liver disease studies were too heterogeneous for pooled analysis and were assessed qualitatively.

Findings

Researchers identified 102 relevant studies in the three selected areas: 47 studies for depression, 14 studies for osteoarthritis, and 41 studies for liver disease. The majority of the studies enrolled small numbers of patients, and the quality of the studies varied greatly, as judged by the Jadad criteria. Results are summarized in five evidence tables. After removal of duplicate studies, the distribution of studies across the three selected areas was as follows:

Out of 39 unique studies considered, 28 studies were included in a meta-analysis of the efficacy of SAMe to decrease symptoms of depression.

• Compared to placebo, treatment with SAMe was associated with an improvement of approximately 6 points in the score of the Hamilton Rating Scale for Depression measured at 3 weeks (95 percent CI [2.2, 9.0]). This degree of improvement is statistically as well as clinically significant and is equivalent to a partial response to treatment. Too few studies were available for which a risk ratio could be calculated for either a 25 percent or 50 percent improvement in the Hamilton Rating Scale for Depression. Therefore a pooled analysis could not be done, but the results generally favored SAMe compared to placebo.
• Compared to treatment with conventional antidepressant pharmacology, treatment with SAMe was not associated with a statistically significant difference in outcomes (risk ratios for a 25 and for a 50 percent decrease in the Hamilton Rating score for depression were 0.99 and 0.93, respectively; effect size for the Hamilton Rating score for depression measured continuously was 0.08 (95 percent CI [-0.17, -0.32])).

Out of 13 unique studies considered, 10 studies were included in a meta-analysis of the efficacy of SAMe to decrease pain of osteoarthritis.

• One large randomized clinical trial showed an effect size in favor of SAMe of 0.20 (95 percent CI [-0.39, - 0.02]) compared to placebo, thus demonstrating a decrease in the pain of osteoarthritis.
• Compared to treatment with nonsteroidal anti-inflammatory medication, treatment with SAMe was not associated with a statistically significant difference in outcomes (effect size 0.11; 95 percent CI [0.56, 0.35]).

Eight unique studies were included in a meta-analysis of the efficacy of SAMe to relieve pruritus and decrease elevated serum bilirubin levels associated with cholestasis of pregnancy.

• Compared to placebo, treatment with SAMe was associated with an effect size of nearly a full standard deviation (-0.95; 95 percent CI [-1.45, -0.45]) for decrease in pruritus and of over one and one-third standard deviations (-1.32; 95 percent CI [-1.76, -0.88]) for decrease in serum bilirubin levels.
• In two clinical trials that were not pooled, conventional therapy (ursodeoxycholic acid) was favored over SAMe for the treatment of pruritus. One of them was statistically significant. For serum bilirubin, the results of three small trials varied, and no conclusion could be drawn.

Out of 10 unique studies considered, six studies were included in a meta-analysis of the efficacy of SAMe to relieve pruritus and decrease elevated bilirubin levels associated with intrahepatic cholestasis caused by a variety of liver diseases.

• Compared to placebo, treatment with SAMe for pruritus was associated with a risk ratio of 0.45, meaning that patients treated with SAMe were twice as likely as placebo treated patients to have a reduction in pruritus (95 percent CI [0.37, 0.58]).
• Studies that compared SAMe to active therapy were insufficient in number to permit pooled analysis.

Twenty remaining studies were too heterogeneous with respect to both diagnosis (a wide variety of liver conditions) and outcomes to permit pooled analysis. They were assessed qualitatively.

Future Research

The review has identified a number of promising areas for future research. These areas are discussed briefly.

A need exists for additional review studies, studies elucidating the pharmacology of SAMe, and clinical trials. A better understanding of the risk benefit ratio of SAMe compared to conventional therapy, especially for depression and osteoarthritis, is very important. To that end, additional analysis of existing data could be done, but it would likely be more productive to support new definitive clinical studies to address this issue.

Good dose-escalation studies have not been performed using the oral formulation of SAMe for depression, osteoarthritis, or liver disease. Once efficacy of the most effective oral dose of SAMe has been demonstrated, larger clinical trials are indicated for the use of SAMe for depression, osteoarthritis, and cholestasis. Such trials would need to enroll large numbers of patients with homogeneous diagnoses, and focus on significant clinical outcomes. Ideally, they would compare SAMe to both placebo and standard care. Information on side effects and adverse events should be systematically collected in these trials.

For liver conditions other than cholestasis, additional smaller trials should be conducted to ascertain which patient populations would benefit most from SAMe, and what interventions (dose and route of administration) are most effective. Additional smaller clinical trials of an exploratory nature should be conducted to investigate uses of SAMe to decrease the latency of effectiveness of conventional antidepressants and to treat of postpartum depression.

Source: The National Center for Complementary and Alternative Medicine at the National Institutes of Health. Current as of August 2002.

next: St. John's Wort and the Treatment of Depression
~ depression library articles
~ all articles on depression

female sexual problems

Vaginismus occurs when the vagina is unable to relax and permit the penetration of the penis during intercourse (or inhibit medical examination or tampon insertion).

Normally, the vaginal sphincter (which is a group of muscles) keeps the vagina closed. When it expands and relaxes, it enables intercourse, childbirth, medical examination and insertion of tampons. Vaginismus occurs when the vagina is unable to relax and permit the penetration of the penis during intercourse (or inhibit medical examination or tampon insertion). When vaginismus occurs, the sphincter goes into spasm. Vaginismus is not uncommon. With some women, vaginismus prevents all attempts at successful intercourse. It may occur later in life, even if a woman has a history of enjoyable and painless intercourse.

What Causes Vaginismus

Frightening or painful experiences can cause some women to believe or fear that penetration might be painful or even impossible.

Cultural and religious backgrounds are sometimes strict and can reinforce the 'ideal of the virgin'.Concepts such as penetration, intercourse and even sex can cause fear or trepidation in the mind of a young woman. Stories about painful first intercourse reinforce fears of penetration. Fear about penetration can compound and create a pattern of sexual anxiety, causing the vagina to remain dry and unrelaxed before intercourse.

Recurring or lasting vaginismus can derive from adolescent conditioning and unsatisfying early sexual experience or abuse. In some cases, vaginismus may eventuate after a history of successful and enjoyable intercourse - due to a vaginal infection, the physical after-effects of childbirth, tiredness or some other cause, which causes painful intercourse, possibly leading to a pattern of further vaginismus even though the original cause has disappeared. The anticipation of painful penetration - even though there may be no physical impediment to normal, painless intercourse - can be a common cause of vaginismus.

Treatment for Vaginismus

It is possible to practice techniques which will prevent vaginismus, that is, to train the vaginal sphincter to relax and permit penetration?

It usually takes time and practice to 'retrain' the vaginal sphincter. Until you are confident that you can master these techniques, you and your partner should avoid attempts at forced penetration and concentrate on other sexual activities...of which there are many! Make sure that any pain you have experienced during attempts at intercourse is not a result of medical problems - consult your medical practitioner.

If the problem is found to be vaginismus try these techniques over time. Don't rush but set your goals - 'I will have enjoyable sex and enjoyable sex includes intercourse', 'I will enjoy penetrative sex'.

Relaxed and on your own, think about a level of discomfort you can tolerate for a short moment, deliberately let your vagina become tense. Then let it relax, use a lubricant and gradually insert your fingers or a vaginal dilator (obtainable through your doctor, or a sex therapist) into your vagina until you reach, but don't exceed, your discomfort level. Be realistic - allow some discomfort, perhaps expect it, but don't let it become painful - just progress one step at a time. There is no hurry, practice in the bath or shower if you prefer.

Find a position that suits you - lying back, on your side, squatting. It's your choice - allow yourself to enjoy the experience. Over time, progress further into your vagina, moving from your little finger to your index finger or perhaps using a larger dilator. Feel confident - you're not inserting anything into your vagina that won't fit; after all the vagina can expand to allow the birth of a baby! As you progress, incorporate water-based lubricants such as KY Jelly in your training - use as much or as little as you like. Gradually, you will train your vagina to expect these new feelings and larger objects.

Now you're ready to practice with your partner. Follow the steps again, but this time let your partner insert their finger or the dilator into your vagina - gradually. Proceed with patience - eventually your vagina will relax enough to permit your partner's penis to penetrate, perhaps a little at a time. Practice, practice, practice. Allow the experience to be enjoyable for you both - take time to discover each other's desires and turn-ons.

next: Types of Male and Female Sexual Problems

teenage sex

We know that for centuries rapists have used alcohol as a means to sedate their victims in order to commit sexual assault. Today, rapists can choose a wide variety of substances to commit crimes of assault.

In recent years, survivors of sexual assault have been drugged by sedating substances, usually when slipped into a beverage. These drug related sexual assaults pose unique difficulties for both survivors and for those who are trying to reduce the risk. The general advice provided here is that any substance can be used to sedate women and men for the purposes of raping them.

Based on the information the authorities have about the use of these date rape drugs, we know that people of all ages are potentially vulnerable -- however, we also know that both sexual assault and high risk drinking occurs more amongst youth and young adults. We also know that both young women and young men have been drugged and sexually assaulted, and that women are more likely to be sexually assaulted, not only with rape drugs, but in other ways as well.

What exactly are date rape drugs?

Technically speaking, any substance that renders you incapable of saying "no" or asserting yourself and your needs can be used to commit rape.

This can include things like alcohol, marijuana or other street drugs, designer or club drugs like ecstasy, over-the-counter sleeping pills and antihistamines, even cold medications. However, the term "date rape drug" usually applies to the drugs Rohypnol, Gamma Hydroxy Butyrate (GHB) and Ketamine Hydrochloride.

How date rape drugs work

Rape survivors generally report that they had consumed little or no alcohol and felt terribly inebriated. The next thing they remember is waking up with the knowledge of having survived a sexual assault. One can only imagine how frightening this may be for survivors. Imagine what it is like to wake up, knowing that you have been assaulted, but not being able to recall the details. The effect of many of the drugs is that they cause amnesia and unclear memories.

Police authorities report these date rape drugs (Rohypnol, Gamma Hydroxy Butyrate (GHB) and Ketamine Hydrochloride) are being used in bars, nightclubs, restaurants, parties, coffee shops, etc. One survivor recounted a story of being raped after being drugged on an airplane flight. Imagine how she felt when no one helped her, and she was incapable of preventing the assault.

What makes these date rape drugs so effective

The drugs are virtually undetectable; they are tasteless, odorless and colorless. All traces of the drugs leave the body within 72 hours of ingestion and are not found in any routine toxicology screen or blood test - doctors and police have to be looking specifically for them and they have to look quickly! Date rape drugs are easily slipped into drinks and food and are very fast acting. They render the victim unconscious but responsive with little or no memory of what happens while the drug is active in their system. The drugs also make the victim act without inhibition, often in a sexual or physically affectionate way. Like most drugs, date rape drugs render a person incapable of thinking clearly or of making appropriate decision. This makes for a very passive victim, one who is still able to play a role in what is happening but who will have no clear memory of what happened after-the-fact. Without any memory of events the victim is often unaware that they have even been raped, and if they are aware or have suspicions they make very poor witnesses.

How do you know if someone has used a date rape drug on you?

It is difficult, but not impossible to know. First, there are some very clear signs that sexual activity has taken place even if you have no memory of actually "doing it." (It is important to note here that if you have had sex but can not remember doing it or offering consent you have been raped under the law, whether a date rape drug has been used or not.) Signs that a sexual assault has taken place can include; soreness or bruising in the genital area, soreness or bruising in the anal area, bruising on the inner and/or outer thighs, bruising on the wrists and forearms, defensive bruising or scratching (the kind that would occur during a struggle), used condoms near you or in nearby garbage containers, and traces of semen or vaginal fluids on clothes, body or nearby furniture.

Since people who have been slipped a date rape drug appear to others to be very intoxicated, an extremely reliable sign that you have been raped using a date rape drug is gossip from others about your behavior or the behavior of those around you. Aside from indications of sexual activity, other clues that a date rape drug may have been given to you include:

• feeling "hung-over" despite having ingested little or no alcohol
• a sense of having had hallucinations or very "real" dreams
• fleeting memories of feeling or acting intoxicated despite having taken no drugs or drinking no alcohol
• no clear memory of events during an 8 to 24 hour period with no known reason for the memory lapse
• and stories from others about how intoxicated you seemed at a time when you know you had taken no drugs, medications or alcohol

Short of being told that you have been given a date rape drug, there is no way to be sure without medical testing. If you suspect that you have been given a date rape drug you need to get to a hospital quickly and you must request that you be properly tested. The drugs can be found in your system if you act quickly. If you suspect that you have been raped using any one of these drugs go to a hospital and request a preliminary rape exam with testing for date rape drugs. This is the only way to know for sure.

How Can You Protect Yourself from Being a Victim of a Date Rape Drug?" />

How can you protect yourself from being a victim of a date rape drug?

The introduction of date rape drugs into mainstream culture has put a very powerful weapon in the hands of sexual predators. Rapes can be easily committed behind a foggy haze of intoxication often leaving the rape victim oblivious to the fact they have been assaulted. It is a frightening thought that begs the question: "What, if anything, can be done to stop a person from falling victim to a rape using a date rape drug?" There are some simple behavior modifications you can make to ensure that you do not fall prey to a rapist armed with a date rape drug. To protect yourself always follow these simple rules:

• Don't accept drinks from other people.
• Open containers yourself.
• Keep your drink with you at all times, even when you go to the bathroom.
• Don't share drinks.
• Don't drink from punch bowls or other large, common, open containers. They may already have drugs in them.
• Don't drink anything that tastes or smells strange. Sometimes, Gamma Hydroxy Butyrate (GHB) tastes salty.
• Have a non-drinking friend with you to make sure nothing happens.
• Keep your eyes and ears open; if there is talk of date rape drugs or if friends seem "too intoxicated" for what they have taken, leave the party or club immediately and don't go back!

If these behavior modifications don't feel like enough protection, or if you don't think you can follow these rules on a given night, you do have another option. There is a new defense against date rape drugs that has recently been approved for use in North America; it is a simple and inexpensive test kit that can be used to detect the presence of date rape drugs in drinks. The so-called "Drink Safe Technology" is actually a package of drink testing strips or coasters that work like those litmus paper strips you use in chemistry class. The strips and coasters change color when they come in contact with a date rape drug. The strips fit in your purse or pocket and can be used quickly and discretely. To find out more about "Drink Safe" visit the website at http://www.drinksafetech.com.

If you think that you have been drugged and raped:

• Go to the police station or hospital right away.
• Get a urine (pee) test as soon as possible. The drugs leave your system quickly. Rohypnol leaves your body 72 hours after you take it. Gamma Hydroxy Butyrate (GHB) leaves the body in 12 hours.
• Don't urinate before getting help.
• Don't douche, bathe, or change clothes before getting help. These things may give evidence of the rape.
• You also can call a crisis center or a hotline to talk with a counselor. One national hotline is the National Domestic Violence Hotline at 800-799-SAFE or 800-787-3224 (TDD). Feelings of shame, guilt, fear and shock are normal. It is important to get counseling from a trusted professional.

GHB (Gammahydroxybutyrate)

GHB is used in some countries as a general anesthetic, treatment for insomnia, treatment for alcoholism, an aid in childbirth by increasing the strength of contractions and decrease in pain, and assists in dilation of cervix.

The street names for GHB are: Easy Lay, EZ Lay, Liquid Ecstasy, Ellie, Clear X, Liquid X, X-rater, XTC, Chemical X, Liquid Dream, Scoop, Scoop Her, Get-Her-to-Bed.

GHB is an odorless, colorless, liquid that acts on the central nervous system as a depressant/anesthesia. It looks exactly like water. It was banned in the United States in 1990 under the Samantha Reid Date-Rape Prohibition Act of 2000. It is also illegal in Canada and many parts of Europe. It is not produced or manufactured by any pharmaceutical company; instead it is made in illegal drug labs or by amateur chemists in their homes. It can be easily made with common and readily available ingredients and novice chemistry skills and the recipe is easy to find. Making, possessing and/or using this drug is illegal.

GHB is used as a recreational drug often at Rave parties and offers an alcohol and hangover free high

GHB can cause these problems:

• euphoria
• amnesia
• intoxication
• dizziness
• visual hallucinations
• enhances state of relaxation, desire, enjoyment, and decreases inhibitions
• problems seeing
• unconsciousness (black out)
• problems breathing
• dream-like feeling
• coma
• death

GHB begins to take effect 10 - 15 minutes after ingestion. The effects last for 3 - 6 hours when taken without alcohol and 36 - 72 hours when mixed with alcohol or other drugs. In very high dosages unconsciousness, or even coma, can occur within 5 minutes.

Ketamine Hydrochloride

Ketamine is a legal drug sold as a veterinary sedative or hospital grade anesthesia and goes by the brand names Ketaset® or Ketalar®. It is in the same family of drugs as PCP or angel dust (phencyclidine). When used in humans, the drug acts as a dissociative anesthesia; it renders the user vaguely aware of, but comfortably detached from, all bodily sensations.

In undiluted form it looks like an off-white powder, in diluted form it looks like slightly cloudy water.

The street names for Ketamine are: Special K, Super K, K, OK, KO, Vitamin K, Kid Rock, Ket Kat, Make-Her-Mine.

Ketamine can cause these problems:

• has a dissociative action, type of out of body experience, yet conscious
• loss of grasp with primary senses - distorted perceptions of sight and sound
• feelings of peace, detachment from body, enter a type of transitional world of darkness, leading to a near death type of experience
• often causes those under influence to feel connected to emotionality
• loss of memory, includes amnesia, hallucinations
• patients state they are awake but paralyzed
• can cause violent reactions in some who take the drug in excessive amounts, with aggressive displays, impaired self control, hallucinations and other toxic side effects such as nausea and vomiting
• problems breathing
• dream-like feeling
• coma
• death

When taken orally or nasally (snorted), the effects of Ketamine take 10 - 20 minutes to be realized. When taken intravenously the effects are instantaneous. The effects last less than 3 hours and the drug is detectable in the system up to 48 hours depending on the method of ingestion. Since it is often mixed with other mind-altering drugs, like heroin and cocaine, many people do not ever realize they have been given this substance.

What makes the 3 main date rape drugs - Rohypnol, Gamma Hydroxy Butyrate (GHB) and Ketamine - so dangerous?

These date rape drugs are sometimes used to assist in a sexual assault. Sexual assault is any type of sexual activity that a person does not agree to. It can include inappropriate touching, vaginal penetration, sexual intercourse, rape, and attempted rape. Because of the effects of these rape drugs, victims may be physically helpless, unable to refuse sex, and can't remember what happened. The date rape drugs often have no color, smell, or taste and are easily added to flavored drinks without the victim's knowledge. There are at least three date rape drugs:

Rohypnol (flunitrazepam)

Rohypnol is a prescription sedative/depressant belonging to the Benzodiazepine family of drugs used as a powerful sedative or sleeping medication. Similar drugs in this family are Valium and Halcion.

The street names for Rohypnol are: Rophy, Ruffles, Roofies, Ruffies, Ruff Up, Rib, Roach 2, R2, R2-Do-U, Roche, Rope, Ropies, Circles, Circes, Forget It, Forget-Me-pill, Mexican Valium.

This drug is not manufactured or approved for use in North America but can be found as a street drug. Rohypnol is a pill and dissolves in liquids. New pills turn blue when added to liquids. However, the old pills, with no color, are still available. The tablet is white and looks slightly smaller than an aspirin and may be packaged in bubble wrap, which gives it a false sense of safety or legality.

The effects of Rohypnol can be felt within 20-30 minutes of ingestion with the strongest effects felt within one to two hours. The effects may last up to 8 hours. Mixed with alcohol, the effects last longer, up to 36 hours. After ingestion it can be found in the blood stream for 24 hours and in urine samples for 48 hours.

Rohypnol can cause these problems:

• can't remember what happened while drugged
• sleepiness
• muscle relaxation or loss of muscle control
• drunk feeling
• problems talking
• difficulty with motor movements
• loss of consciousness
• confusion
• problems seeing
• dizziness
• lower blood pressure
• nausea, stomach problems

The pills are small and white with a split-pill line on one side and the word "ROCHE" with the number 1 or 2 in a circle stamped on the other. They are quickly dissolved in liquid especially when crushed first.

next: Dating an Older Guy